Background and aims The recurrence of obstructive sleep apnoea (OSA) after positive airway pressure (PAP) therapy termination has physiological consequences that may increase cardiovascular (CV) risk. We aimed to determine whether PAP termination is associated with an increased incidence of major adverse CV events (MACE) compared with adherent PAP continuation. Methods Data from the Pays de la Loire Sleep Cohort were linked to the French national health insurance database to identify incident MACE (composite outcome of mortality, stroke and cardiac diseases), and CV active drug (lipid-lowering, antihypertensive and antiplatelet drugs, beta-blockers) adherence (medication possession ratio ≥80%). The association of PAP termination with MACE was evaluated using a time-dependent survival Cox model, with adjustment for confounders including CV active drug status. Results After a median follow-up of 8 years, 969 of 4188 included patients (median age 58 years, 69.6% men) experienced MACE, 1485 had terminated PAP while 2703 continued PAP with at least 4 hours/night use. 38% of patients were adherent to all CV drugs in the PAP continuation group versus 28% in the PAP termination group (p<0.0001). After adjustment for confounders, PAP termination was associated with an increased risk of MACE (HR (95% CI): 1.39 (1.20 to 1.62); p<0.0001). PAP termination was not associated with incident heart failure and coronary artery disease. Conclusions In this multicentre clinical-based cohort involving 4188 patients with OSA, PAP termination compared with adherent PAP continuation was associated with an increased risk of MACE. More research is needed to determine whether support programmes on PAP adherence could improve CV outcomes. No data are available.

中文翻译：

---

气道正压通气终止与阻塞性睡眠呼吸暂停患者死亡率和非致命性心血管事件的相关性


背景和目标 气道正压通气 （PAP） 治疗终止后阻塞性睡眠呼吸暂停 （OSA） 的复发具有可能增加心血管 （CV） 风险的生理后果。我们旨在确定与依从性 PAP 继续治疗相比，PAP 终止是否与主要不良 CV 事件 （MACE） 的发生率增加有关。方法 将来自 Pays de la Loire 睡眠队列的数据与法国国家健康保险数据库相关联，以确定事件 MACE （死亡率、中风和心脏病的复合结局） 和 CV 活性药物 （降脂、抗高血压和抗血小板药物、β 受体阻滞剂） 依从性 （药物持有率 ≥80%）。使用时间依赖性生存 Cox 模型评估 PAP 终止与 MACE 的关联，并调整包括 CV 活性药物状态在内的混杂因素。结果 中位随访 8 年后，4188 例患者中有 969 例 （中位年龄 58 岁，69.6% 男性） 经历过 MACE，1485 例终止了 PAP，而 2703 例继续 PAP，每晚至少 4 小时使用。PAP 持续治疗组 38% 的患者对所有 CV 药物依从性，而 PAP 终止组为 28% （p<0.0001）。调整混杂因素后，PAP 终止与 MACE 风险增加相关 （HR （95% CI）：1.39 （1.20 至 1.62）;p<0.0001）。PAP 终止与心力衰竭和冠状动脉疾病无关。结论 在这个涉及 4188 例 OSA 患者的多中心临床队列中，与依从性 PAP 继续相比，PAP 终止与 MACE 风险增加相关。需要更多的研究来确定 PAP 依从性支持计划是否可以改善 CV 结局。没有可用的数据。